ENHANCING COMMUNICATION SKILLS FOR STUDENTS WITH AUTISM SPECTRUM DISORDERS (ASD) IN THE GENERAL EDUCATION CLASSROOM Modu

1. ENHANCING COMMUNICATION SKILLS FOR STUDENTS WITH AUTISM SPECTRUM DISORDERS (ASD) IN THE GENERAL EDUCATION CLASSROOM Module 3 Lesson 1 Receptive Language Skills

2. Outline • Lesson 1 • Overview of Communication and Language Skills • Receptive Language • Characteristics • Strategies for the Classroom • Lesson 2 • Expressive Language • Characteristics • Strategies for the Classroom • Lesson 3 • Augmentative Communication (AAC) Strategies for the Classroom • Overview • AAC Options

3. OVERVIEW OF COMMUNICATION AND LANGUAGE SKILLS

4. Introduction and Definitions • Individuals with ASD have varying degrees of impairment in communication skills. The communication characteristics they manifest can vary along a continuum ranging from mild to severe. • Communication involves the ability to comprehend language, express language, and use language to interact with others. Typically developing persons learn to comprehend and use verbal and nonverbal language to communicate. • Students with ASD commonly have deficits in these areas of communication. Their challenges in social interactions and behavior also affect their ability to communicate and relate to others in everyday activities. • These communication characteristics pose important implications for instruction, suggesting that certain content and instructional approaches may be more effective than others.

5. Students with ASD have impairments in communication (at least one of the following): • Delayed or absent spoken language; this is usually not accompanied by attempts to compensate with other forms of communication such as pointing or gestures • Marked impairment in language used for social interaction, such as the ability to initiate and sustain conversation when speech is present • Stereotyped and repetitive use of language or idiosyncratic language • Lack of varied and appropriate imitative or pretend play adapted from Paul, 2007

6. Communication and language characteristics commonly seen include: • Lack of joint attention - students with ASD often do not communicate in order to share focus and interact with others. • This results in delays and differences in language development in children with ASD. • Students with ASD use language most often to communicate wants and needs (by requesting or protesting) (Paul, 2007; ASHA, 2006).

7. Characteristics (continued): • Students with ASD exhibit difficulty with specific language and related cognitive skills, such as: • Understanding and using verbal and nonverbal communication • Literacy skills • The ability to problem solve and self monitor goal-directed behavior • Higher level or symbolic play (ASHA, 2006).

8. Characteristics (continued): • Students with ASD often show differences and delays in receptive and expressive language, particularly related to: • Semantics (content or meaning). This involves: • knowledge of vocabulary; • ability to express and understand concepts about objects and events, and relations among these objects and events, and • Pragmatics (language used for social communication). This involves using language for various purposes or communicative intents (e.g., to comment, ask, direct, converse). Pragmatics also involves discourse skills (turn-taking, topic maintenance, topic change), and the flexibility to modify speech for different listeners and social situations (Paul, 2007; ASHA, 2006).

9. Characteristics (continued): • When speech is present, a relative strength is usually expressive language “form” (this includes grammar/syntax, morphology, and sound production/phonology). So a student may use sentence structures and grammar at a higher level than their understanding of the words used. • Form(syntax, morphology, and phonology) – refers to grammar or sentence components such as nouns, verbs, the basic noun phrase and verb phrase; and sentence types, and the ability to produce sounds in words (Paul, 2007).

10. Characteristics (continued): • Expressive language often includes immediate or delayed echolalia . • Speech usually has unusual intonation, pitch, rate, rhythm, volume, and other differences(Paul, 2007).

11. Characteristics (continued): • Nonverbal students with ASD: • may not develop speech, or may develop speech at a slower rate than peers , • typically do not spontaneously replace speech with communicative gestures and pointing, and • use fewer conventional gestures and pointing than typically developing peers (Paul, 2007).

12. RECEPTIVE LANGUAGE

13. Students with ASD may have substantial delays in receptive language ability (Beukelman & Mirenda, 2005). They may compensate with strengths in other areas such as visual memory. • Potential classroom application: • Use the student’s strengths such as visual skills for instruction. For example, when giving an assignment, include visual/pictured information, such as to depict math or vocabulary concepts. • Include tasks that are successful for students with ASD. For example, they may do better on tasks that require rote memorization, such as counting. • Target receptive joint attention, comprehension, and responsiveness by stressing key words and slowing your rate of speech; using simple, routine, repetitive language; and including activities and items of interest to the student to encourage him to look or attend (Paul, 2007).

14. Receptive (and expressive) vocabulary is frequently restricted to nouns or object labels • Other word forms (such as action words or verbs, modifiers such as adjectives, and adverbs) develop later in children with ASD. Words other than nouns require an ability to determine and interpret another’s focus of attention and intention (ASHA, 2006). • Potential classroom application: When talking to students with ASD, to help them comprehend, it may help to stress key words (e.g., Teacher instructs, “Get your pencil out,” stressing the word pencil, pointing to a pencil). Use visuals to teach other word forms such as verbs, adjectives, and adverbs. Stress these words in several activities, including activities of interest to the student.

15. Students with ASD may not understand the conventional meaning of words or phrases but may instead hear a word or “chunk” of language (ASHA, 2006). • Potential classroom application: Stress key words (e.g., outside, the teacher says “Throw the ball”) when needed to help the student attend to the key word and not phrase. Use the key word in several activities, with several items, etc., to promote generalization. Try slower or deliberate rate of speech to help with auditory processing of information.

16. Students with ASD show literalness in their understanding of language (Paul, 2007; ASHA, 2006). • They may have trouble understanding that words have synonyms or multiple meanings, or that there can be different interpretations of the same words in different contexts such as jokes. This may also affect their ability to apply information learned in one situation to another. • Potential classroom application: Use visuals for teaching words or concepts that are not concrete; teach specific words and concepts in several activities, as they apply to various situations, to help with generalization.

17. Students with ASD have difficulty understanding the nonverbal communication of others (ASHA, 2006). • This may include facial expressions, gestures, eye gaze, or body postures of others, and taking the perspective of others, such as to understand how others think and feel (Beukelman & Mirenda, 2005). • Potential classroom application: When giving instructions or discussing a lesson, demonstrate or model task requirements, give specific or concrete information, use short repetitive language and predictable routines when possible to facilitate comprehension.

18. They may not respond as well in tasks requiring typical interpersonal interaction (Paul, 2007) • Example: The student with ASD may not do as well when asked to answer classroom activity questions, directed to go to another person to get or deliver something, or directed to imitate someone (gesturally or vocally). They may have difficulty understanding various communicative intents of others. • Potential classroom application: To encourage participation in tasks that require interactions, helpful strategies may include– involving a favorite activity (to promote joint attention), repetition and modeling, having a favorite activity naturally happen next as reinforcement, and including visual cues. Expand students’ understanding of communicative intents (such as when someone asks a question, shows, etc.).

19. Students with ASD may show differences in related skills such as sensory processing abilities, which affect their responsiveness. This might include over or under-responding or delayed response times (ASHA, 2006). • Potential classroom application: • Review classroom schedules or task sequence so students know what to expect; prepare them for changes that may happen, and try to reduce sensory issues students may have (e.g., may not respond as well to certain textured foods, toys, materials, etc.). • Practice target skills in a variety of activities and situations. • Use simple input language (key words), and pause or provide a little extra time (time delay) to help students process information and respond .

20. As language comprehension improves, students with ASD may continue to need help to understand and know what to do, especially in new situations; they may perseverate by continuing to use the “old” strategies in new situations (ASHA, 2006). • Potential classroom application: Continue to teach specific words and concepts in new situations,/settings to help with generalization, continue visual prompts (which can promote greater independence), with plans to systematically fade prompts.

21. SummaryWays to adapt activities to promote receptive language skills • Teach in usually occurring activities and situations -- Teach specific skills in several activities, as they apply to various situations, allowing many opportunities to practice and to help with generalization. Include activities and items of interest and predictable routines to promote participation and learning. Include tasks that are usually successful for them; example: they may do better on tasks that require rote memorization, such as counting. • Use students’ strengths, such as visual skills, during instruction with students with ASD -- Example: when giving an assignment, include visuals such as to picture concepts, word forms such as verbs, adverbs, and adjectives; concepts or words that are not concrete, and steps in a task. continued on next slide

22. Summary Ways to adapt activities to promote receptive language skills • When giving instructions or discussing a lesson with students with ASD, use strategies to help them process information, attend to key words, and comprehend -- It may be helpful to stress important words in several activities, beginning with activities of interest to the student. Try slower or deliberate rate of speech, pause or provide a little extra time (time delay); and use simple input and routine, repetitive language (as in theme-based lessons) to help students process information. Visuals also promote comprehension. • Encourage participation and interaction in tasks -- Helpful strategies may include: involving a favorite activity (for joint attention), repetition and modeling, having a favorite activity naturally happen next as reinforcement, and visual cues. • Specific teaching strategies may depend on the student’s language level and other needs -- Collaborate with your speech-language therapist and other team members to individualize instruction that addresses students’ specific receptive language needs.

23. MORE STRATEGIES FOR THE CLASSROOM

24. Effective systematic instruction in the general education classroom includes “naturalistic instruction.” • Naturalistic instruction to promote receptive language skills and participation involves structuring the environment, and adapting methods and activities to promote receptive language skills and increase participation. • The next few slides describe some of the naturalistic instructional procedures recommended for use in classrooms and other settings to promote receptive language in students with ASD (Noonan & McCormick, 2006). Note that there is considerable overlap among these strategies.Use the strategies, or steps within strategies, alone or in combination with other techniques.

25. Responsive interaction strategies (following the student’s lead) – these promote a student’s joint attention, balanced communication, responsiveness, and engagement with others and the environment in a conversational way (Noonan and McCormick, 2006; Landa, 2007). • Specifically, the teacher follows the student’s attention focus or lead, imitates or balances turns to maintain the activity or topic, talks about what the student is doing or about the activity, responds to all of the student’s verbal and nonverbal communication and matches the language complexity of the student’s language. • She then tries to get the student to respond to or imitate her, to expand his skills. continued on next slide

26. Responsive interaction strategies (continued) • Example: Teaching comprehension of nouns and verbs using this strategy (with a student who sometimes says single words and is not responding to interactions from the teacher or others) – Today, the student is playing with his favorite toy dog. The teacher brings out another toy dog and holds it too, imitating what the student does and saying what the student is doing each time (e.g., “dog, holding dog, dog up,” etc.). She then makes the dog run and says “dog run” and laughs, hoping to facilitate the student doing the same thing. The teacher slowly brings in other actions in the same way. • Imitation acknowledges the student’s act and “invites” a response from him.

27. Environmental arrangement strategies – these promote students’ communication, and are easy to include throughout the day. To facilitate receptive language, use any of the strategies below, and then immediately provide the material or activity when the student responds. These strategies should increase the likelihood that the student will want to attend, process, and respond: • Provide interesting materials and activities • Place desired materials in sight but out of reach • Offer small portions of needed or desired materials • Provide many choice-making opportunities, setting up situations in which students need assistance, and • Create unexpected situations. continued on next slide

28. Environmental arrangement strategies (continued) • Example: Tom is nonverbal, loves puzzles and play dough. Students in class are to request the items they want for a project. The teacher asks him what he wants to use for his project, and he does not answer the question. The teacher then shows him two possibilities: play dough or crayons, and asks, “Do you want play dough or crayons?” Tom responds by reaching for the play dough. The teacher is able to say, “Oh you want play dough” and helps him point. Tom then gets the play dough for his project. • In this case, including materials of interest and a choice-making setup encourage Tom to learn to answer the question (to follow the task direction).

29. Modeling – this can be used to teach turn-taking, imitation, basic vocabulary, and conversational skills within activities. • Begin with an appropriate teaching opportunity (e.g., the student is doing something he likes, there is something that he wants) and establish joint attention first. Provide a model to encourage imitation. Use this technique when it is appropriate for the student to receive the item or activity he wants. See next slide for additional information and example. continued on next slide

30. Modeling (continued) – Steps and example: Step 1: Establish joint attention – Sue is to get a bin for a class project that involves something she likes - pudding. The teacher gets beside her and also looks at the bins (each bin has a key word printed and pictured). Step 2: Present a verbal model that labels or describes the focus of interest - The teacher says,” Pudding, you’re making pudding,” and touches the recipe that shows a picture /word for pudding. Step 3: When the student imitates the model, acknowledge and expand his/her response and provide access to the material or activity - Sue touches the picture for pudding. The teacher says, “Yes, you’re making pudding,” touches the recipe again, and says, “Let’s find the pudding box. Make pudding.” Step 4: If the student does not imitate or respond appropriately, repeat the model. If the student again does not respond correctly, provide corrective feedback and help him access the material or activity - In this case, the teacher could help her match the picture/word for pudding on the recipe to the one on the correct bin that will have the pudding ingredients

31. Incidental Teaching – the goal of incidental teaching is to expand the student’s language or conversation in an activity of interest. This strategy differs from the others in that it is used after the student has produced a verbal or nonverbal request. • Example: Matt likes to write on the chalkboard and has communicated this interest. Every day when he comes to class, he goes up to the board and writes his name for the attendance activity. Each week, the teacher uses that activity to add a new verb to the directions she gives him to work on his goal to expand his comprehension of verbs. The first week - the instruction was to erase the board (to get ready for the activity). The second week - the instruction was to write (actually, copy) his name. The third week - Matt was to give the chalk to the next student, etc. Any naturalistic or other instructional strategy could be used here to encourage Matt’s comprehension and participation.

32. Embed instructional episodes for classroom goals in regularly occurring activities. The 2 main steps involved include: • Step One – Select activities and arrange the environment in which you plan to embed teaching episodes for academic goals and objectives. • Step Two - Decide how the targeted skills will be taught. It is the teacher’s responsibility to ensure that antecedents for producing desired responses occur throughout the day (e.g., by providing choices, modeling, or other teaching techniques such as prompting/fading prompts, etc.). The next two slides include more information about each step.

33. Step 1: Select activities and arrange the environment (adapted from Noonan & McCormick, 2006 from Bricker & Norstad, 1990; Landa, 2007): • Select activities that group similar objectives for different students.Example: telling stories with props is an activity that lends itself to teaching “identifying objects by their function” (receptively, such as by pointing or sorting). • Select activities that group different objectives for the same student.Example: Joe has 3 objectives that can be taught during snack preparation: a language objective (“comprehending adjectives”), cognitive/pre-linguistic objective (“matching colors and shapes”), and fine motor/self-care objective (carrying out direction to “pour”). • Select activities that can be adapted for varying age and skill levels.Example: an activity such as “Yes, you can,” which teaches children to help with simple tasks, can easily be adapted to different ages and skill levels: Jen is assigned tasks that are equally important but simplified (i.e., directions are given to her using key words or phrases) to help her understand tasks better. continued on next slide

34. Select activities that require minimal adult direction and assistance.Example: most independent-play activities and some clean-up routines require minimal direct assistance from adults, once they begin. • Select activities that provide many opportunities for student initiations.Example: the activity “Up, up, and away” requires children to name a peer and then pass a balloon to that peer; each game provides many opportunities for children to initiate to peers. In the area of receptive language, the student has many opportunities to respond appropriately to peer initiations and can begin to understand how and what happens when he initiates interactions. • Select activities that are motivating and interesting. Routines/activities that are fun and inherently reinforcing are more likely to keep students engaged and therefore learning in any skill area. continued on next slide

35. Select activities that involve play. Play or games can be a platform for social engagement. For young and older students, “play” is a context in which communication exchanges are made and language can be learned and practiced. • Design activities in which modeling can be used and the student’s imitation skills can be facilitated and practiced. Example: Students are to put their colored pencils away in a box but Tom needs help. The teacher begins to put them in the box and then gives Tom the box and encourages him to do the same with the rest. • Arrange physical space in the classroom to promote student learning. Examples: To promote comprehension of adjectives, the classroom may have adjective words and pictures in the room that the teacher can use as prompts. To teach math, the room can have a grocery store configuration to make the activity more interesting, etc. Also see slide 24. continued on next slide

36. Step 2: Decide how the targeted skills will be taught. • An instructional plan or matrix can be organized to include: • Activity or occasion for instruction – e.g., art class-- student likes to color • Schedule- e.g., 2:00 art class, 1:00 free play can include art • Physical positioning or materials- e.g., materials will be in a bin labeled “art” with picture symbol for art; have word and picture prompts nearby • Intervention strategies- e.g., for student objective: to show understanding of three action verbs (color, cut, and paste); always ensure joint attention; student is offered choices, teacher will model and use visual prompts continued on next slide

37. The instructional plan, continued: • Student Response – e.g., student will follow instructions to pick a picture to color, use scissors to cut it out, and glue stick to paste on construction paper; teach each step one at a time • Consequence for correct response- e.g., verbal acknowledgement and reinforcement (say, “Color, red” and give student color of choice) • Consequence for incorrect response- e.g., teacher will model correct action, include visuals

38. SUMMARY: Ways to promote receptive language across classroom activities, using naturalistic instruction • Follow the student’s lead • Make environmental arrangements • Model communication skills and request that the student imitate • Continually expand the students’ communication skills by elaborating • on what they like or say • Plan learning opportunities in regularly occurring activities-- create a • matrix or list of students’ communication goals and classroom • activities to show where and how instruction can be implemented • Collaborate with team members, including speech-language therapist, • to address students’ specific language needs • Use naturalistic strategies above, with other teaching techniques, to • promote language. Examples: • Use time delay or pause, and then model and request imitation • Include extra prompts or cues to help students understand and to • expand language skills; gradually reduce prompts and cues over • time

39. Module 3 Lesson 1 Activity • Look at the example for using responsive teaching strategies– following the child’s lead– on slide 23. In this example, what could the teacher target next as she teaches comprehension of nouns and verbs? • Using the example on slide 25 for using environmental arrangement strategies, describe how other environmental strategies could be used? • On slide 27, an example of modeling is given. When the student brings the bin of ingredients back to her seat to follow the pictured steps, what are some more key words that the teacher could add and model, to promote Sue’s comprehension and follow-through? • In the incidental teaching example in slide 28 to expand a student’s skills, any naturalistic or other instructional technique could be used to encourage Matt’s comprehension and participation. Describe what this might look like for each verb.

40. References American Speech-Language-Hearing Association. (2006). Principles for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span [Technical Report]. Available from 222.asha.org/policy. Beukelman, D.R., & Mirenda, P. (2005). Augmentative and Alternative Communication: Supporting children & adults with complex communication needs (3rd ed.). Baltimore, MD: Brookes Publishing. Landa, R. (2007). Early communication development and intervention for children with autism. Mental Retardation and Developmental Disabilities Research Reviews, 13, 16-25. Noonan, M.J., & McCormick, L. (2006). Young children with disabilities in natural environments. Baltimore, MD: Brookes Publishing. Paul, R. (2007). Language disorders from infancy through adolescence (3rd ed.). St. Louis, Missouri: Mosby Elsevier. Wetherby, A.M., & Prizant, B.M. (Eds.). (2000). Autism spectrum disorders: A transactional developmental perspective (Vol. 9). Baltimore, MD: Brookes Publishing. Woods, J.J., & Wetherby, A.M. (2003). Early identification of and intervention for infants and toddlers who are at risk for autism spectrum disorder. Language, Speech, and Hearing Services in Schools, 34, 180-193.